The association between objectively measured physical activity and morning symptoms in COPD

Abstract

PurposeThe morning is the most bothersome period for COPD patients. Morning symptom severities in different Global Initiative for Chronic Obstructive Lung Disease (GOLD) stages are not well studied. Furthermore, factors that are associated with morning symptoms, especially the associations with objectively measured physical activity, are also not well described.Materials and methodsThe aim of this cross-sectional observational study was to assess morning symptom severity in GOLD A, B, C and D patients, according to the definitions of the GOLD 2015 statement. Morning symptoms were assessed with the PRO-Morning COPD Symptoms Questionnaire. Differences in morning symptom severity between different COPD stages were assessed with a one-way analysis of variance followed by post hoc analyses. The association between dyspnea severity (assessed with the modified Medical Research Council scale), health status, airflow limitation, lung hyperinflation, anxiety and depression, inflammatory parameters, exacerbations, objectively measured physical activity parameters retrieved from accelerometry and morning symptom severity was evaluated using linear regression analysis.ResultsEighty patients were included (aged 65.6±8.7 years, forced expiratory volume in 1 second [FEV1] % predicted 55.1±16.9). Mean (±SD) morning symptom score was 19.7 (±11.7). Morning symptom severity was significantly different between COPD stages: mean (±SD) score in GOLD A was 9.7 (±7.2), in GOLD B 19.8 (±10.7), in GOLD C 8.6 (±9.3) and in GOLD D 23.8 (±11.2) (p<0.001). Lower health status, more symptoms, increased anxiety and depression, less physical activity (all p<0.001) and lower FEV1 (p=0.03) were associated with an increased morning symptom severity.ConclusionPatients with overall more symptomatic COPD have significant higher morning symptom scores. Morning symptom severity was associated with important clinical outcomes: lower health status, more symptoms, increased anxiety and depression, fewer steps a day, less time in moderate and vigorous physical activity with bouts of at least 10 minutes and lower FEV1. The data suggest that morning symptoms should be carefully assessed in addition to assessment by general COPD-specific questionnaires, especially in those with more symptomatic COPD. More research is needed on potential therapies to improve morning symptoms; this study shows potential targets for intervention.

Physical activity in the morning and afternoon is lower in patients with chronic obstructive pulmonary disease with morning symptoms

“…Detailed inclusion/exclusion criteria have been reported previously [ 14 ]. In summary, included in the study were patients aged 40 to 80 years.…”

“…Studies have shown that morning symptoms are negatively associated with self-reported physical activity [ 13 ]. A negative association between morning symptoms and overall physical activity has been reported [ 14 ]. However, the relation between morning symptoms and objectively measured physical activity during different parts of the day has not been studied yet.…”

<p>The Relationship Between Morning Symptoms and the Risk of Future Exacerbations in COPD</p>

“…This result was consistent with the conclusion of previous multi-factor analysis. 10,30 In this study, the morning symptoms were negatively correlated with lung function, while positively -with mMRC, CAT, and CCQ score. In the multiple linear regression analysis, we found that poorer health was associated with more severe morning symptoms, a finding confirmed by previous studies in which CAT score was an independent risk factor for morning symptoms.…”

Daily objective physical activity and sedentary time in adults with COPD using spirometry data from Canadian Measures Health Survey

“…Yet, using the NHANES cohort, Martinez and colleagues [36] demonstrated that patients with undiagnosed COPD had better lung function and health status compared to those with physician-diagnosed COPD. As previously shown [37,38], this may explain why CHMS participants with undiagnosed COPD (13.4%) reported higher physical activity levels. is inconsistency may Canadian Respiratory Journal be explained, at least in part, by the fact that the classification of participants with mild-to-moderate airflow obstruction based only on spirometry data is associated with higher risk of misclassification [31].…”